If you are a patient of our clinic and would like to purchase more contact lenses simply complete the following form. One of our staff will call you to confirm your order.

One of our staff will call you to confirm we have received your order, and to confirm your preferred method of delivery (i.e. in-person office pick-up, or direct shipped).

Payments for direct shipped orders will be taken during this confirmation call.

Payments for orders to be picked up at the office, can be paid-in person at the time of pick-up.

Your contact lens prescription is valid for one year. If your prescription has expired we will contact you.

Please note that all the fields are mandatory.

Full Name*:

Telephone*:

Email*:

for confirmation email only, will not be given to a third party.

Which eye(s)*:

Please choose Right Eye Left Eye Both Eyes

Quantity*:

Please choose 1 Year 6 months 3 months

Message:

send